Factors limiting the motor rehabilitation of elderly disabled persons with lower limb loss

Background. Amputation of a limb leads to significant changes in a person's life, since mobility restrictions affect the ability to perform daily tasks and professional duties.

Aim. To identify factors that negatively affect the results of motor rehabilitation of elderly disabled people with lower limb loss.

Material and methods. Data on patients with postamputation lower limb defects, who were divided into two groups, were analyzed. The first group (comparison group) included patients aged 60 years and younger — 171 people, including 141 men and 30 women; the second group (main group) consisted of patients over 60 years of age — 260 people, including 207 men and 53 women. Patients of the second group with a satisfactory result of rehabilitation were included in subgroup 2A, with an unsatisfactory result — in subgroup 2B. The influence of gender, age, level of mobility, cognitive abilities, daily activity, level of amputation, presence of concomitant diseases, body mass index, duration of the post-amputation period on the result of rehabilitation in the second group were assessed. Statistical analysis used the χ2 test, the Mann–Whitney U test for independent groups, and binary logistic regression.

Results. The indicators of mobility before prosthetics in elderly people with disabilities did not differ significantly from those in people under the age of 60, however, by the end of the rehabilitation course, the optimal level of mobility in the room (without using a wheelchair) was reached by 75.4% of the comparison group and only by 52.7% of the main group (ꭓ2=22.59, р <0.001). Further analysis showed that at the age of over 66.5 years, the risk of obtaining an unsatisfactory result of motor rehabilitation is 2.3 times higher (p=0.006) than at the age of 60–66.5 years. In older women, this risk is 2.7 times higher than in men of the same age (p=0.014). With a body mass index of more than 28.5 kg/m2, the risk increases by 3.2 times (p=0.001), and with a duration of the post-amputation period at the time of primary prosthetics of more than 1 year, it increases by 2.6 times (p=0.008) compared with lower values of these indicators in elderly people with disabilities.

Conclusion. The factors associated with the unsatisfactory result of motor rehabilitation of elderly disabled people with lower limb loss are: age over 66.5 years, female sex, body mass index over 28.5 kg/m2, duration of the post-amputation period at the time of primary prosthesis over 1 year.